Objective To investigate the protective effect of ischemic preconditioning (IPC) and penehyclidine hydrochloride (PHC) on the spinal cord against ischemia-reperfusion injury induced by aortic cross-clamping in rabbits. Methods Twenty-four rabbits were randomly divided into sham operation group (A), ischemia-reperfusion injury group (B) and IPC+PHC group (C). In group C, IPC was performed for 5 min, followed by reperfusion for 30 min, and PHC (0.2 mg/kg) was given at 20 min of rcperfusion. Then, in group B and C, the infrarenal aorta was clamped for 40 min followed by 7 d reperfusion. The aorta was not clamped in group A. The plasma concentrations of malondialdehede (MDA), superoxide dismutase (SOD), creatine kinase (CK) and creatine kinase BB isoenzyme (CK-BB) were assayed at 10 min before clamping, before unclamping, at 60 min and on the 7 th day after unclamping. After an operation, the neurological outcomes of the hind limbs were evaluated, the morphology of the spinal cord was observed, and the apoptotic spinal cord cells were measured by immunohistochemical technique. Results The concentrations of MDA, CK and CK-BB after ischemia-reperfusion in group B were increased significantly compared with those before clamping and　those in group A (P<0.05 or 0.01); the concentrations in group C were higher than those before clamping　(P<0.05), but lower significantly than those in group B (P<0.01), and not significantly different from　those in group A. SOD was opposite. The apoptotic cells in group B were much more than that in groupA and in group C, but the number in group C was significantly higher than that in group A (P<0.01). The incidence rate of paralysis in group C was significantly lower than that in group B, and the neurological score of hinder limb was higher in group C than in group B (P<0.01). Pathological changes of the spinal cord was milder in group C than in group B. Conclusion The combination of IPC and PHC can protect the spinal cord from ischemia-reperfusion injury in rabbits; the main mechanism may be increasing antioxidant potential and preventing cell injury.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.